Abstract
Sleep impairment is a common clinical condition in patients with rheumatoid arthritis. There are several confounding factors for poor sleep quality including inflammation, pain, comorbidities, and medications. Consequences of impaired sleep vary within a wide spectrum, as well. These include exacerbated inflammation and inflammation-related symptoms, mental and physical fatigue, mood disorders, daytime sleepiness, and poor quality of life. Sleep impairment in rheumatoid arthritis and its association with disease-related variables including health-related quality of life have been studied several times in the literature. Therefore, it would be of value to review the existing data on the crosstalk between sleep and rheumatoid arthritis. In the present article, the mechanism, confounders, and consequences of this association will be reviewed in detail. The evaluation of sleep impairment in rheumatoid arthritis along with the potential management strategies will be discussed.
Similar content being viewed by others
References
Lo CM, Lee PH (2012) Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults. Health Qual Life Outcomes 10:72
Sateia MJ (2014 Nov) International classification of sleep disorders-third edition: highlights and modifications. Chest 146(5):1387–1394
Dong X, Wang Y, Chen Y, Wang X, Zhu J, Wang N et al (2018) Poor sleep quality and influencing factors among rural adults in Deqing, China. Sleep Breath. https://doi.org/10.1007/s11325-018-1685-8
Pehlivan S, Karadakovan A, Pehlivan Y, Onat AM (2016) Sleep quality and factors affecting sleep in elderly patientswith rheumatoid arthritis in Turkey. Turk J Med Sci 46:1114–1121
Stipelman BA, Augustson E, McNeel T (2013) The relationship among smoking, sleep, and chronic rheumatic conditions commonly associated with pain in the National Health Interview Survey. J Behav Med 36:539–548
Mahowald ML, Mahowald MW (2000) Nighttime sleep and daytime functioning (sleepiness and fatigue) in well-defined chronic rheumatic diseases. Sleep Med 1:179–193
Wong ITY, Chandran V, Li S, Gladman DD (2017) Sleep disturbance in psoriatic disease: prevalence and associated factors. J Rheumatol 44:1369–1374
Bagnato GL, Fiorenza A, Cordova F, Roberts WN, Moore C Jr, Greco D et al (2016) Clinical, autoimmune, and psychiatric parameters correlate with sleep disturbance in patients with systemic sclerosis and rheumatoid arthritis. Clin Exp Rheumatol Suppl 100:49–55
Nicassio PM, Ormseth SR, Kay M, Custodio M, Irwin MR, Olmstead R et al (2012) The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain 153:107–112
Albayrak Gezer İ, Balkarli A, Can B, Bağçaci S, Küçükşen S, Küçük A (2017) Pain, depression levels, fatigue, sleep quality, and quality of life in elderly patients with rheumatoid arthritis. Turk J Med Sci 47:847–853
Austad C, Kvien TK, Olsen IC, Uhlig T (2017) Sleep disturbance in patients with rheumatoid arthritis is related to fatigue, disease activity, and other patient-reported outcomes. Scand J Rheumatol 46:95–103
Gjevre JA, Taylor-Gjevre RM, Nair BV, Lim HJ (2012) Do sleepy rheumatoid arthritis patients have a sleep disorder? Musculoskeletal Care 10:187–195
Goes ACJ, Reis LAB, Silva MBG, Kahlow BS, Skare TL (2017) Rheumatoid arthritis and sleep quality. Rev Bras Reumatol Engl Ed 57:294–298
Kim JH, Park EC, Lee KS, Lee Y, Shim S, Kim J et al (2016) Association of sleep duration with rheumatoid arthritis in Korean adults: analysis of seven years of aggregated data from the Korea National Health and Nutrition Examination Survey (KNHANES). BMJ Open 6:e011420
Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L et al (2014) Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life. J Clin Med Res 6:44–52
Son CN, Choi G, Lee SY, Lee JM, Lee TH, Jeong HJ et al (2015) Sleep quality in rheumatoid arthritis, and its association with disease activity in a Korean population. Korean J Intern Med 30:384–390
Szady P, Bączyk G, Kozłowska K (2017) Fatigue and sleep quality in rheumatoid arthritis patients during hospital admission. Reumatologia 55:65–72
Westhovens R, Van der Elst K, Matthys A, Tran M, Gilloteau I (2014) Sleep problems in patients with rheumatoid arthritis. J Rheumatol 41:31–40
Løppenthin K, Esbensen BA, Jennum P, Østergaard M, Tolver A, Thomsen T et al (2015) Sleep quality and correlates of poor sleep in patients with rheumatoid arthritis. Clin Rheumatol 34:2029–2039
Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Fitzgerald JD, Ranganath VK et al (2012) Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep 35:537–543
Guo G, Fu T, Yin R, Zhang L, Zhang Q, Xia Y et al (2016) Sleep quality in Chinese patients with rheumatoid arthritis: contributing factors and effects on health-related quality of life. Health Qual Life Outcomes 14:151
Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K (2015) Relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis. J Caring Sci 4:233–241
Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31:1409–1417
Purabdollah M, Lakdizaji S, Rahmani A (2017) Relationship between Sleep, Pain and Inflammatory Markers in Patients with Rheumatoid Arthritis. J Caring Sci 6:249–255
Abbasi M, Yazdi Z, Rezaie N (2013) Sleep disturbances in patients with rheumatoid arthritis. Niger J Med 22:181–186
Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O (2011) Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol 29:S92–S96
Sangle SR, Tench CM, D’Cruz DP (2015) Autoimmune rheumatic disease and sleep: a review. Curr Opin Pulm Med 21:553–556
Chung WS, Lin CL (2018) Sleep disorders associated with risk of rheumatoid arthritis. Sleep Breath doi. https://doi.org/10.1007/s11325-018-1639-1
Kang JH, Lin HC (2012) Obstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study. Sleep Med 13:583–588
Hsiao YH, Chen YT, Tseng CM, Wu LA, Lin WC, Su VY et al (2015) Sleep disorders and increased risk of autoimmune diseases in individuals without sleep apnea. Sleep 38:581–586
Chen WS, Chang YS, Chang CC, Chang DM, Chen YH, Tsai CY et al (2016) Management and risk reduction of rheumatoid arthritis in individuals with obstructive sleep apnea: a nationwide population-based study in Taiwan. Sleep 39:1883–1890
Bollinger T, Bollinger A, Skrum L, Dimitrov S, Lange T, Solbach W (2009) Sleep-dependent activity of T cells and regulatory T cells. Clin Exp Immunol 155:231–238
Bjurström MF, Olmstead R, Irwin MR (2017) Reciprocal Relationship Between Sleep Macrostructure and Evening and Morning Cellular Inflammation in Rheumatoid Arthritis. Psychosom Med 79:24–33
Irwin MR, Olmstead R, Carroll JE (2016) Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry 80:40–52
Rohleder N, Aringer M, Boentert M (2012) Role of interleukin-6 in stress, sleep, and fatigue. Ann N Y Acad Sci 1261:88–96
Davis CJ, Krueger JM (2012) Sleep and Cytokines. Sleep Med Clin 7:517–527
Crofford LJ, Kalogeras KT, Mastorakos G, Magiakou MA, Wells J, Kanik KS et al (1997) Circadian relationships between interleukin (IL)-6 and hypothalamic-pituitary-adrenal axis hormones: failure of IL-6 to cause sustained hypercortisolism in patients with early untreated rheumatoid arthritis. J Clin Endocrinol Metab 82:1279–1283
Shoda N, Seichi A, Takeshita K, Chikuda H, Ono T, Oka H et al (2009) Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features. Eur Spine J 18:905–910
Nicassio PM, Ormseth SR, Custodio MK, Olmstead R, Weisman MH, Irwin MR (2014) Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in rheumatoid arthritis patients. Behav Sleep Med 12:1–12
Wells GA, Li T, Kirwan JR, Peterson J, Aletaha D, Boers M et al (2009) Assessing quality of sleep in patients with rheumatoid arthritis. J Rheumatol 36:2077–2086
Katz P (2017) Causes and consequences of fatigue in rheumatoid arthritis. Curr Opin Rheumatol 29:269–276
Yoon BY, Lee JH, Shin SY (2017) Discrepancy between subjective and objective measures of cognitive impairment in patients with rheumatoid arthritis. Rheumatol Int 37:1635–1641
Kaeley GS, MacCarter DK, Goyal JR, Liu S, Chen K, Griffith J et al (2018) Similar Improvements in Patient-Reported Outcomes Among Rheumatoid Arthritis Patients Treated with Two Different Doses of Methotrexate in Combination with Adalimumab: Results From the MUSICA Trial. Rheumatol Ther 5:123–134
Barnabe C, Crane L, White T, Hemmelgarn B, Kaplan GG, Martin L et al (2018) Patient-reported Outcomes, Resource Use, and Social Participation of Patients with Rheumatoid Arthritis Treated with Biologics in Alberta: Experience of Indigenous and Non-indigenous Patients. J Rheumatol 45:760–765
Fragiadaki K, Tektonidou MG, Konsta M, Chrousos GP, Sfikakis PP (2012) Sleep disturbances and interleukin 6 receptor inhibition in rheumatoid arthritis. J Rheumatol 39:60–62
Pope J, Bingham CO 3rd, Fleischmann RM, Dougados M, Massarotti EM, Wollenhaupt J et al (2015) Impact of certolizumab pegol on patient-reported outcomes in rheumatoid arthritis and correlation with clinical measures of disease activity. Arthritis Res Ther 17:343
Gossec L, Danré A, Combe B, Le Loët X, Tebib J, Sibilia J et al (2015) Improvement in patient-reported outcomes after rituximab in rheumatoid arthritis patients: An open-label assessment of 175 patients. Joint Bone Spine 82:451–454
Taylor-Gjevre RM, Gjevre JA, Nair BV, Skomro RP, Lim HJ (2011) Improved Sleep Efficiency after Anti-Tumor Necrosis Factor α Therapy in Rheumatoid Arthritis Patients. Ther Adv Musculoskelet Dis 3:227–233
Karatas G, Bal A, Yuceege M, Yalcin E, Firat H, Dulgeroglu D et al (2017) The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients. Clin Rheumatol 36:45–50
Lee YC, Lu B, Edwards RR, Wasan AD, Nassikas NJ, Clauw DJ et al (2013) The role of sleep problems in central pain processing in rheumatoid arthritis. Arthritis Rheum 65:59–68
Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E (2016) Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 68:81–90
Taylor-Gjevre RM, Gjevre JA, Nair B, Skomro R, Lim HJ (2011) Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthritis. Musculoskeletal Care 9:152–159
Druce KL, Cordingley L, Short V, Moore S, Hellman B, James B et al (2018) Quality of life, sleep and rheumatoid arthritis (QUASAR): a protocol for a prospective UK mHealth study to investigate the relationship between sleep and quality of life in adults with rheumatoid arthritis. BMJ Open 8:e018752
Detert J, Dziurla R, Hoff P, Gaber T, Klaus P, Bastian H et al (2016) Effects of treatment with etanercept versus methotrexate on sleep quality, fatigue and selected immune parameters in patients with active rheumatoid arthritis. Clin Exp Rheumatol 34:848–856
Strand V, Kremer JM, Gruben D, Krishnaswami S, Zwillich SH, Wallenstein GV (2017) Tofacitinib in combination with conventional disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis: patient-reported outcomes From a phase III randomized controlled trial. Arthritis Care Res (Hoboken) 69:592–598
Strand V, Burmester GR, Zerbini CA, Mebus CA, Zwillich SH, Gruben D et al (2015) Tofacitinib with methotrexate in third-line treatment of patients with active rheumatoid arthritis: patient-reported outcomes from a phase III trial. Arthritis Care Res (Hoboken) 67:475–483
Strand V, van Vollenhoven RF, Lee EB, Fleischmann R, Zwillich SH, Gruben D et al (2016) Tofacitinib or adalimumab versus placebo: patient-reported outcomes from a phase 3 study of active rheumatoid arthritis. Rheumatology 55:1031–1041
Buttgereit F, Smolen JS, Coogan AN, Cajochen C (2015) Clocking in: chronobiology in rheumatoid arthritis. Nat Rev Rheumatol 11:349–356
Buttgereit F, Doering G, Schaeffler A, Witte S, Sierakowski S, Gromnica-Ihle E et al (2008) Efficacy of modified-release versus standard prednisone to reduce duration of morning stiffness of the joints in rheumatoid arthritis (CAPRA-1): a double-blind, randomised controlled trial. Lancet 19:371:205–214
Buttgereit F, Mehta D, Kirwan J, Szechinski J, Boers M, Alten RE et al (2013) Low-dose prednisone chronotherapy for rheumatoid arthritis: a randomised clinical trial (CAPRA-2). Ann Rheum Dis 72:204–210
Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL et al (2018) EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:797–807
Durcan L, Wilson F, Cunnane G (2014) The effect of exercise on sleep and fatigue in rheumatoid arthritis: a randomized controlled study. J Rheumatol 41:1966–1973
McKenna S, Tierney M, O’Neill A, Fraser A, Kennedy N (2018) Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis. Rheumatol Int 38:845–853
Løppenthin K, Esbensen BA, Østergaard M, Jennum P, Tolver A, Aadahl M et al (2015) Physical activity and the association with fatigue and sleep in Danish patients with rheumatoid arthritis. Rheumatol Int 35:1655–1664
Evans S, Moieni M, Lung K, Tsao J, Sternlieb B, Taylor M et al (2013) Impact of iyengar yoga on quality of life in young women with rheumatoid arthritis. Clin J Pain 29:988–997
Morsley K, Berntzen B, Erwood L, Bellerby T, Williamson L (2018) Progressive resistance training (PRT) improves rheumatoid arthritis outcomes: A district general hospital (DGH). Musculoskeletal Care 16:13–17
Bakir E, Baglama SS, Gursoy S (2018) The effects of reflexology on pain and sleep deprivation in patients with rheumatoid arthritis: A randomized controlled trial. Complement Ther Clin Pract 31:315–319
McKenna S, Donnelly A, Fraser A, Comber L, Kennedy N (2017) Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review. Rheumatol Int 37:963–974
Funding
None to declare.
Author information
Authors and Affiliations
Contributions
ICB: contributed to the conception and design of the study; collection and interpretation of data; drafting and revising the article; approval of the final version.
Corresponding author
Ethics declarations
Conflict of interest
The author declares no conflicts of interest.
Rights and permissions
About this article
Cite this article
Coskun Benlidayi, I. Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatol Int 38, 2183–2192 (2018). https://doi.org/10.1007/s00296-018-4155-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-018-4155-5